Health Reform in Massachusetts

From September 2008 to May 2009, I was on a Kaiser Media Fellowship to follow health reform efforts in Massachusetts. My stories during that period appeared on WFCR public radio, on NPR, and on other outlets. Since then, I have continued to cover the topic as health reform remains a key local and national issue.

The Path to Primary Care: Who Will Be The Next Generation of Frontline Doctors?

Thursday, January 29th, 2015

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Remember the grandfatherly doctor who makes house calls and treated three generations of the same family, nursing them through everything from skinned knees to cancer?

For the most part, that Norman Rockwell ideal is long gone, and replaced with busy group practices that usher through patients in 15-minute increments. But even that model is struggling. There simply aren’t enough primary care doctors, period. So when the Affordable Care Act passed in 2010, the government included money to train and inspire a new generation of primary care doctors. Are those efforts working?

For a year, I followed a group  of doctors-in-training in Western Massachusetts as they weighed this major career decision, while trying out the profession first-hand.

This documentary was funded by a fellowship from the Association of Health Care Journalists and the Commonwealth Fund. [Full transcript and photos at NEPR.net]

Listen to Rob Rosenthal’s interview with me on HowSound Podcast, hosted by Transom.org, here.

Read my companion story in the Boston Globe here.

 

And to hear a follow-up feature, which looks at some unconventional, activist efforts to reverse the trend away from primary care, click here.

Near-Universal Health Coverage….Does Not Prevent Need for Free Clinics

Thursday, May 8th, 2014

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Massachusetts has the highest rate of health insurance in the country — but that still leaves thousands of people who can’t afford the health care they need. NEPR’s Karen brown spent time at one clinic that’s offering medicine at the ultimate bargain. (Aired May 2014)

 

Tip Sheet for Journalists

Friday, April 22nd, 2011

In April 2011, I took part in the Association of Health Care Journalists’ national conference in Philadelphia — where I was on a panel called “Lessons Learned from Massachusetts Health Reform.”  Here is a tip sheet that I distributed at the panel. It’s meant to help guide the local reporter who is charged with the daunting task of covering their state’s emerging health reform efforts.

SOME TIPS FOR COVERING THE IMPACT OF HEALTH REFORM ON A LOCAL LEVEL

(by Karen Brown, WFCR Public Radio, Amherst, MA)

VISIT THE ‘UNUSUAL’ SUSPECTS

State officials, insurance executives and policy experts are the obvious places to start on many issues. But to learn what’s happening in the trenches, make frequent phone calls or visits to:

– Community health centers, which are often the places that coordinate sign-ups for the new health programs. They see who’s falling through the cracks and why. They can often also put you in touch with consumers to tell their own stories.

– Primary care doctors. They can talk about waiting lists and complex insurance rules and what their patients are frustrated or happy about.

– Young invincibles. Men in their twenties remain one of the least insured group, because they just don’t think they’ll need insurance – even the subsidized kind. Find out who’s trying to circumvent the insurance mandate, and why.

– Gatherings of “middle income” earners, like artists or acupuncturists, for instance – groups that are likely to be most affected by new programs designed for people up to 3 or 4 times the poverty level. Some will be delighted because they’ve finally been given access to affordable insurance, and some will have fallen through the cracks.

– Consumer advocates can be very helpful sources, but don’t rely exclusively on those groups for examples of “real people.” They are often hand-picked to make a certain point (which may be a good one, but still….) Why not approach people in the video store…or supermarket…or local park. Everyone is affected by health insurance, and you’ll get a good cross section of experiences.

WHO’S FALLING THROUGH THE CRACKS?

You may be surprised to learn how many cracks there are in new programs, however well designed – and those cracks help inform public opinion. In Massachusetts, for instance: if your employer offers health insurance but the premium is too high for you to afford…. you’re not eligible for a state subsidy (even if your salary is otherwise low enough to qualify.) Also — there’s a fairly large population of people who make too much to qualify for a subsidy…but too little to comfortably afford private insurance. Those are the people who feel hardest hit by the insurance mandate – and many of them are quite vocal.

DEVIL IS IN THE DETAILS:

Ask people to describe their individual experiences dealing with an insurance exchange or government programs. Sometimes you’ll find trends, other times you’ll find exceptions to the rule, but either way you’ll learn a lot about what informs public opinion. For example, stories about being kept on hold for hours … and then given conflicting information from different offices… and being told you qualify for coverage only to receive a letter of denial in the mail – these are the things that define success or failure from the consumer perspective.

UNINTENDED CONSEQUENCES:

There are always plenty – and each one makes for a good story. For example, in Massachusetts, the shortage of primary care doctors got worse after more people got health insurance ….And more fly-by-night insurers started to prey on confused consumers who knew they were required to buy health insurance but didn’t realize those health plans had to meet certain standards. Advocates will point out that unintended consequences do not negate all the good that comes out of reforms – and that’s a fair point – so make sure you put it all in context.

SOMETHING HAS TO GIVE:

Expanding health coverage costs a lot of money. What are state and local governments giving up to pay for that? In Massachusetts, in order to avoid limiting state-funded benefits or capping enrollment, the state has had to take money out of the outreach and education budget (which funded health outreach organizations)….out of Medicaid reimbursement rates to doctors and hospitals (affecting the bottom line of safety net institutions)….and out of the healthcare subsidy for legal immigrants (which led to a lesser health plan for one group of people.)

BE AWARE OF LANGUAGE NUANCES:

There is a difference between “access to insurance” and “access to care.” For instance, many more people in Massachusetts now have coverage….but that doesn’t mean they’re always getting the care they need, at a price they can afford, in a timely fashion. Also be aware that “reform” means different things to different people. In Mass, state-subsidized health coverage was greatly expanded, but the payment system stayed essentially the same. Explain those distinctions frequently, because even though health journalists know the jargon and the politics like the back of their hands, most consumers are still confused.

BE THICK-SKINNED AROUND POLITICAL ALLEGIANCES

Since health reform is such a politicized issue, including at the state level, it’s hard to report on the nitty gritty without having to carefully navigate political allegiances. It’s common to be accused of anti-reform bias when reporting on consumer complaints – and conversely, to be accused of acting as a government mouthpiece when reporting on people happy with the way things have changed.

Doctor Chooses Retirement Over Bureaucracy

Wednesday, April 13th, 2011

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Doctors across the country say practicing medicine isn’t what it used to be. The ever-growing maze of government and insurer bureaucracies takes time away from actual patient care. Many small private practices are joining larger groups to be more efficient. But one doctor in Springfield, Massachusetts is going a different way. After four decades in practice, he’s shutting down.  (First aired on WFCR, April 2011)

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Health Insurers Weigh In on Cost Cutting

Tuesday, December 7th, 2010

Massachusetts health insurers say that Governor Deval Patrick’s efforts to put a lid on premium prices is a threat to their viability. But industry executives insist they do want to work with the state’s leaders to hold down costs for everyone. WFCR’s Karen Brown spoke recently with Andrew Dreyfus, the new CEO of the state’s largest nonprofit insurer — Blue Cross Blue Shield of Massachusetts. (Aired on WFCR, December 7, 2010)

To hear story on WFCR’s website, click here

New health insurance rules go into effect this week (spot news)

Tuesday, September 21st, 2010

Six months after a national health reform was passed, several new provisions are going into effect this week. As WFCR’s Karen Brown reports, Massachusetts consumers will see some changes in their insurance policies, but not as many as those in other states. (This aired on Sept. 21, 2010.)

To listen on WFCR’s website, click here.